Provider Demographics
NPI:1356509582
Name:CHIROPRACTIC ASSOCIATES OF SOUTHWEST FLORIDA, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF SOUTHWEST FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ESMAEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMALIAZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-437-2885
Mailing Address - Street 1:8801 COLLEGE PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4882
Mailing Address - Country:US
Mailing Address - Phone:239-437-2885
Mailing Address - Fax:239-482-4757
Practice Address - Street 1:8801 COLLEGE PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4882
Practice Address - Country:US
Practice Address - Phone:239-437-2885
Practice Address - Fax:239-482-4757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8642261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381698200Medicaid
FL381698200Medicaid
FL88974Medicare PIN